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25C-107 o0.Y iv.tr pTO _�_ a IE (riff of ir� F $�aaaitchncctta' W Q DEPARTME1J7' OP DUIL.DP\IG INSPPCTIOI.'S — 212 plain Strect ' Municipal Building Northampton, Mass. 01060 ZVOMC R'S CONEPENSA'S'SON MSURANC , AI,AAVIT (Ii ccnscxJ Dcrmi ttcx) � ith a principal place of businessiresidence at: (phone:') -- (M-c--U6 tylstalcta p) do hereby certify, under th.c pa-int and penalties of perjufy, that O I am ao employer providing the following worker's combcns-n:jon cove arc for Illy etuplovees wor-�Dng on"utis job: (t0SU an= Corar.�) (Polio NU--,I r_r) --- (�=:-piano❑ Dam.) .. ( ) I am a sole proprietor, general coouactor or homeowner (circle one) amd have hired the coop actors listed 'below who have the following worker's c-=t LsaDon pokies: (Namc o, Contmc-,o-) (lnRIr3IIC COInDa l)YPGUC-{ ��It1SI1.C) ?:i)IiJUQ I�aIC) (Name of Coacraelor) _ (Uisura.ncr- Comr)an)vPolicy \u.tnccr) (Ei-oir,:tion Date) (Name of Coaa-aeto,) (Insurance CompaDy/PoUcy Nalnbu) (Expiation Date) (Name of Contractor) C1nSuran(r Compaay/Policy Numb:-r) (Expiation Date). (affsGla• ".vocal c5cct ir000c -,,to McL%<:;iaforma�on prrudniag w a.tl I am a sole proprietor and have no one worLz ng for me. ( ) I am.a home owner performing all the work myself. NOTE:plGSc be awart lhat v,t:�lc bomco ivcra�bO ctaploy Pczom w cU- nt 30:D- —coo Cr rc,Ru••ork on.d..c1LZ of not moc<tbcn `t,sv=rj ra u-hirfa tlx botnoaw reach oc oc the p-oupda zppurtca.rl tb=�--o c-c ox Ccne-aDy oeca:drmi to be eanployer unde the wiz aactioa Ab(GLI51=1(S))�a.ppU=L6co by a homoowna for a Pama ra:.y c-rdco=tLc Icg a c-of as c loy.r uoder dt Worke-,Compoma.tioa Ad I—d--d than>oopy of thin=a-co.=may be forrnrded w Lb..DcpanmQa of lnmarJial Ac d—&Offioo or 6,ir.noo for tb. ' eo�a�se vaif esioo and tlLr L-iJtre w scauc bov�ry�e unyl souiov 2S A of htOL 451 aw fad to the i^�OSeion of erimiait peaartirs coot'*�;o of a fiat of up to 51-500.00 andtor i yr of up to one y,and a%i)prn.tio in be form ora Slop Wart Order and a fun o(S 100.00 a my aptiuA tip For dcp.naL:...a1 ux Doty - � Pczmlt Alttmbcr Map —_ Lot ° _Si Lim-oFLia�L,=Ipermivat J . r Versionl.7 Commercial Building Permit May 15,2000 SECTION 10 STRUCTURAL PEEe REVIEW(780 CMR 110 11j Independent Structural Engineering Structural Peer Review Required Yes......❑ No......❑ SECTION 11 „OWNER iAUTHORIZATION j TO SE COMPLETED WHEN OWNERS AGENTD CONTRACTOR APPLIES;FOR BUILDING'PERMIT I, � r as Owner of the subject property hereby authorize bollcl, ' v to act on my behalf, i all mat relative to work authorized by this building permit application. Signature Owner Date I, as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under the pains and penalties of perjury. Print Name Signature of Owner/Agent Date SECTION 12- CONSTRUCTION,.SERVICES ; 10.1 Licensed Construction Supervisor: Not Applicable ❑ Name of License Holder : 0.8 License Number Address Expiration Date Signature Telephone si IgNiL 13 WORKERS' COMPENSATION INSIJRANCEAFFIDAVIT.{M G Ll�-t 152,;§25C(b)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes....... ❑ No...... ❑ Version 1.7 Commercial Building Permit May 15,2000 SECTION,8= PROFESSIONAL DESIGN AND;CONSTRUCTION SER\!iCES -FOR,BUILDINGS AND STRUCTURES SUBJECT TO CONSTRUCTION CONTROt PURSUANT!TD 780 CMR 116{CONTAINING MORE THAN 35 fl00 CF. OF ENCLOS'ED°'SPACE) 9.1 Registered Architect: Not Applicable ❑ Name(Registrant): Registration Number Address Expiration Date Signature Telephone 92 Registered Professional Engineer(s): Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date Name Area of Responsibility Address Registration Number Signature Telephone Expiration Date 9.3 General Contractor Company Name: Not Applicable ❑ Responsible In Charge of Construction Address Signature Telephone Versionl.7 Commercial Building Permit May 15,2000 7.Water Supply(M.G.L.c.40,§54) 7.1 Flood Zone Information: 7.3 Sewage Disposal System: Public ❑ Private ❑ I Zone: Outside Flood Zone ❑ Municipal ❑ On site disposal system ❑ 8. NORTHAMPTON ZONING Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage Setbacks Front Side L: R: L: R: Rear Building Height Bldg. Square Footage % Open Space Footage % (Lot area minus bldg&paved arldn #of Parking Spaces Fill: (volume&Location A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DONT KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DONT KNOW YES IF YES: enter Book Page and/or Document# B. Does the site contain a brook, body of water or wetlands? NO DONT KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained obtained , Date IAssuueed:/ C. Do any signs exist on the property? YES NO V IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property?YES No IF YES, describe size, type and location: Versionl.7 Commercial Building Permit May 15,2000 SECTIEtaN - NStiCIIfll�1fSTQ`RQ3BCISSTHANS;t1Dtl Ci7BIC 1FEf JF A1C3. SE[I! P 1� A £ 6 Interior Alterations Existing Wall Signs Existing Ground Signs Additions❑ Roofing ❑ Exterior Alterations Demolition❑ New Signs [ ] Change of Use [ ] Other [ ] ❑ Accessory Building [ ] Repairs [ ] BRIEF DESCRIPTION: 2)J j i 1��. S, ,,�. ��^M.�C C Tim (� {'� f d. SECTION 5---,USE tROUP,AND CONSTRICT�UN°;TYPE; USE GROUP(Check as applicable) CONSTRUCTION TYPE A Assembly 10 A-1 ❑ A-2 ❑ A-3 ❑ 1A O A-4 ❑ A-5 ❑ 1B ❑ B Business ❑ 2A ❑ E Educational ❑ 2B I ❑ F Factory ❑ F-1 ❑ F-2 ❑ 2C ❑ H High Hazard ❑ 3A ❑ I Institutional ❑ I-1 ❑ I-2 ❑ I-3 ❑ 3B ❑ M Mercantile ❑ 4 ❑ R Residential ❑ R-1 ❑ R-2 ❑ R-3 ❑ 5A ❑ S Storage ❑ S-1 ❑ S-2 ❑ 5B ❑ U Utility ❑ Specify: M Mixed Use ❑ Specify: S Special Use ❑ Specify: CCIMP1FfE ��SEL ION I EXISfIIatG B1lI DING UNQERGC)IlVG#tEN�DVA�IONS,AO1�I1It)NS,AND%OR-CHANGE IN USE Existing Use Group: Proposed Use Group: Existing Hazard Index 780 CMR 34): Proposed Hazard Index 780 CMR 34): -SECTION,6'.'BUILDING HEIGHTAi1tD AREA BUILDING AREA EXISTING PROPOSED NEW CONSTRUCTION 7 ,�� ,�� s gg Floor Area per Floor(sf) sr 1st 2nd , ; k§SIX y 2"d 3 rds 3rd th 4th Total Area (sf) Total Proposed New Construction (sf) Total Height ft Total Height ft----------------- a � � r� .. Versionl.7 Commercial Building Permit May 15,2000 City of Northampton Building Department 212 Main Street .' Room 100 ' Northampton, MA 01060 phone 413-587-1240 Fax 413-587-1272 APPLICATION TO CONSTRUCT,REPAIR, RENOV Q)_OCCUPANCY OF, OR DEMOLISH ANY BUILDING OTHER TH N Y W G r ' � � L! AUG 3 - 4 SECI'IQN 1�.S1Tf INFORMAT301y ' f AR �n take e 1.1 Properly Address: DFFIT t° etedY �7' �I�VI Y �sa � '� g�kxeuza3 � �# b '`"7"�.11e. ";t,;waas 5yn4Fw� " y EIfI7i ISM SECTION Z—'PROPERW©WNERS1 IP/AtMi.ORIZED RGENT 2.1 Owner of Record: q:v r Name(Print) Current Mailing Address: Signatur Telephone 2.2 Authorized Agent• t �6(3,6k' ofm Name(Pri Current Mailing Address: 413 3 Signature Telephone SECTION 3 ESTIMATED CONSTRiJCTION=COSTS Item Estimated Cost(Dollars)to be „'r OfficialVse Only completed by ermit applicant. 1. Building (a)8wlding Penrkfee Cw 2. Electrical fb, EslJ-hiA ted-otal Cost of`" Construction from;"6 " 3. Plumbing � u�lchng Rer �t ee ' 4. Mechanical(HVAC) 5. Fire Protection = . 6. Total = (1 + 2 + 3 +4+ 5) Ch6dk',X nnber This SecEion`.For"Oflt'icial Use Oni Build�rigPermit`Number Date Issued. 'Signature: Building.Commissioner/Inspector of Suildings; Date 12 GRANT AVE BP-2005-0150 GIs#: COMMONWEALTH OF MASSACHUSETTS Zlock:25C- 107 CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2005-0150 Project# IS-2005-0164 Est.Cost: $10000.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const.Class: Contractor: License: Use Group: DAVID NUNEZ 128305 Lot Size(sa. ft.): 4704.48 Owner: HART EDWARD J&JOAN M Zoning.URB Applicant. DAVID NUNEZ AT. 12 GRANT AVE Applicant Address: Phone: Insurance: 41 BRIAR HILL RD (413) 268-3395 WILLIAMSBURGMA01096 ISSUED ON:8111104 0:00:00 TO PERFORM THE FOLLOWING WORK.INSTALL VINYL SIDING & STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Sienature: FeeType• Receipt No: Date Paid: Check No: Amount_ Building 8/11/04 0:00:00 2623 $25.00 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo